The health care crisis Texas isn’t talking about [Opinion]

1of2FILE — Enrollment counselor Sharon Barker’s booth at a back-to-school event at the Martha O'Bryan Center in Nashville, Tenn., Aug. 4, 2017. A federal judge in Texas struck down the Affordable Care Act in December 2018, a day before the deadline to sign up for next year’s coverage in most states, but you might still have time to enroll depending on where you live. (Joe Buglewicz/The New York Times)Photo: JOE BUGLEWICZ, STR / NYT

2of2Texas Rural Hospital, formerly known as Cleveland Regional Medical Center, opened its emergency room on Wednesday. The hospital is owned by the same group that operates Cleveland Emergency Hospital, formerly known as Doctors Diagnostic Hospital.Photo: Vanesa Brashier / Vanesa Brashier

Texas faces a fast-approaching health care crisis that no one is talking about: the expiration of an agreement with the federal government that would strip the state of $6 billion a year.

Texas relies on this funding to care for Texans. It supports hospitals, especially in rural areas, and makes vital medical and behavioral health care more available throughout the state.

The Legislature needs to take action — now, this year — while there is still time to stop this threat to our economy and to the health of our fellow Texans.

Losing these funds would leave hundreds of thousands of Texans without access to community-focused health care. That ultimately increases costs for everyone - employers, taxpayers and the uninsured alike.

This impending crisis stems from the expiration of what is known as the 1115 Healthcare Transformation Waiver. Texas leaders first negotiated the waiver with the federal government in 2011, finding a way to address our state’s unique health care challenges.

The 1115 waiver represents a lifeline to more than 1 million Texans every year. It provides essential resources to physicians, hospitals and providers, and it supports innovative programs that give people without insurance access to cost-effective preventive and primary care services.

Hospitals rely on waiver-based payments — especially in rural areas, where the waiver’s expiration could be catastrophic. In just the past four years, 11 Texas rural hospitals have closed, and more than 20 others are at risk. That risk would grow without this funding, costing rural hospitals, on average, more than $3 million each year.

The waiver also supplies one-third of the funding that community mental health centers need to serve people with serious mental illnesses and developmental disabilities. It helped 173,000 people receive mental health services in 2017 alone. While state leaders have prioritized improving mental health care, any gains would be wiped out by the devastation that would occur without this funding.

Innovations that have improved care delivery and access are also in danger. Right now, Texas should be building on these programs’ successes — if the waiver expires, we might be forced to step backward.

Embedded in these threats is a significant opportunity — Texas can use this negotiation to build an even more effective health care system, leveraging previous investments and ongoing successes to meet our 21st century needs. The state should work to both preserve these vital resources and create access for Texans who need medical care. Without expanding Medicaid, the state could invest these funds even more effectively — creating a system of private market coverage that gives comprehensive and potentially lifesaving access to care to, among others, new mothers, people with pre-existing conditions, and hardworking Texans who cannot afford insurance.

Texas’ legislative leadership remains steadfastly conservative. They have been clear that expanding Medicaid through Obamacare is not the answer in our state.

But if the Legislature sets the right course this session, Texas can establish a conservative, fiscally prudent policy, as Vice President Mike Pence did as governor of Indiana — averting a catastrophe before this funding disappears or the 2020 presidential election creates even more uncertainty.

States such as Utah and Georgia are working with the Trump administration on similar conservative solutions. Texas can, and should, lead the way. We look forward to working with the Legislature, state leaders and the spectrum of stakeholders to show the nation a new way to deliver health care to people who need it.

Curran is president of the Texas Medical Association. Hart is president of the Texas Academy of Family Physicians. Henderson is president and CEO of the Texas Organization of Rural Community Hospitals. Shaw is CEO of the Texas Hospital Association.